View Full Version : Carrying sick people


Pace
23rd Oct 2008, 21:16
I had an unusual request not that long ago. It involved being asked by a friend to fly to Spain to collect a dying friend of his whos family wanted him to return to the UK.

I agreed on principal to do it as a favour but wanted a letter from his family requesting I did the flight on a friendly basis and that they accepted the risk.

I was then informed by another friend that as Captain of an aircraft you are legally reponsible for the passenger and hold a duty of care.

Should he die enroute you could theoretically be sued by the family for the death even if they gave consent?

I believe and I may be wrong that in medical work that duty of care has to pass to a Doctor who stipulates whether the passenger can travel, the level of expertise he needs on board and the equiptment. The doctor then takes that duty of care away from the aircraft commander.

The prospective passenger then died meaning the trip never happened but it does beg the question with any disabled or ill passenger serious or less serious what the Captains responsibility is?

ie if you as a private pilot take someone up for a joy ride who has a known condition or is recovering from an operation or is in advanced state of pregnancy etc and becomes ill during that flight what your level of responsibility is as commander of the craft? I had so much opinion but was never sure which was correct.

Maybe SNS3Guppy or AME PPL might know.

Pace



niknak
23rd Oct 2008, 22:02
Many variables here, the legal aspect being a considerable factor, but I would say that you certainly have a duty of care in what is an emotive and complex issue.

Naturally, you want to do the best for your friends, but have you considered:

1) what the passenger's needs may be during the flight?
2) would it just be you and him? if not, is the aircraft big enough for anyone accompanying him to render any medical assistance when airborne? <consider that if anything did happen - how long would it take to get to the nearest suitably equipped airport? Longer than you'd think.>
3) could you cope with the major distraction of such assistance was being rendered so close to you and fly the aircraft? Come to that, could you fly to your normal high standards knowing that your passenger was so ill, even if nothing was happening?

You've made a very laudable gesture, but this is a specialist type of trip, probably best left to those who do it for a living. Most scheduled and charter airlines can make arrangements for such passengers on routine trips and they're better equipped if anything does go wrong.
I'm sure the family would understand and not think anything less of you if you explain this to them.

Hope it all goes well.

AMEandPPL
23rd Oct 2008, 22:25
Niknak actually summed up most of the important points here very well. I did air ambulance work for many years when I was much younger, and I can tell you that the trip you were contemplating could have turned out to be a much bigger catastrophe than you could ever imagine !

One has every sympathy with the family's wishes (and the patient's, of course !) but it's really a very specialised area of transport, and should be left to those with the knowledge, equipment, suitable aircraft and expertise to do it properly.

To give you just one example of the sorts of cr*p you can encounter : if the patient was really terminally ill, and being returned from Spain to UK, what if he were actually to die while you were in French airspace ? Legally, this is tantamount to dying in France; yet, legally, he has not yet entered France ! ! Bureaucracy rules, OK ? !!!

That's just a taste ! I really wouldn't recommend it, however much you'd like to help out your friends !

Pace
24th Oct 2008, 00:07
AMEand PPL

As stated the poor bloke died literally within a couple of days of the request so probably could have died in the flight especially in a non pressurised twin flying at 10000 feet.

The relevance to this forum is more in the responsibility of the Captain of an aircraft to passengers who have known medical problems.

ie a PPL takes a man and wife flying the wife is in an advanced state of pregnancy. The Pilot knows this and something happens in the flight where the woman looses the child?

Or a friend has a very sick friend and asks a PPL to take him/her for a flight to get them out and brighten them up. Something happens on the flight due to altitude, turbulence or whatever.

Could that PPL be sued by the relatives for not meeting that duty of care by taking the sick person on the flight ??? or by accepting the flight does the sick person accept the consequences of taking the flight?

Pace

SNS3Guppy
24th Oct 2008, 00:14
I've done air ambulance work in Senecas, King Air's, and in Learjets. Some domestic, some international. Most of my flying involved airplanes that were very well equipped with everything that one would have available in a hospital emergency room...including experienced and trained personnel.

I have been out of my seat on the ground, covered in vomit and blood in the ambulance while we tried to get a patient on board, because we ran out of hands in the ambulance. One one occasion when it was bad enough the ambulance driver, one of the emergency technicians assigned, got scared and ran away. I've flown terminally ill children, cancer patients, women in labor, auto wreck trauma victims, gunshot cases, infectious patients, and even a chainsaw to the face.

I once had an individual in the right seat of a Seneca II, who was being taken home from a hospital to a remote location. As this was ad administrative transport, the nurse was not aboard; just me, the patient/passenger, and his wife or girlfriend, in back. Night time, with convective weather around, he had a heart attack. I'm an emergency medical technician (or was; I'm lapsed now), but there's precious little one can do while flying. The patient was a largish gentleman who collapsed forward, unresponsive. I later learned he was a cardiac patient coming home from some tests, not simply someone being transported from A to B. What was a simple flight became complicated in short order.

In the US, an organization called "Angel Flight" has been operating for many years. It consisted of a number of volunteer pilots who would move patients from A to B at little or no expense, using light airplanes. The idea was that many people couldn't afford the costs of the transport, and thus this was a real blessing for them. It's been done successfully for some time. You may be able to contact someone associated with that for direct counsel on what they do.

For my end, a simple transport of an medical patient can become dire and complex, very quickly. You're not close to immediate help. You're taking a patient that is impaired, ill, or broken in some way to higher altitude with lower pressure and oxygen, and placing them in a remote environment under some degree of stress. In a light airplane that can be for some time.

When people say they won't sue you legally, that's fine, but remember that it's the deceased's estate that sues...and that doesn't begin to exist until they're dead. Even the deceased can sign a waiver saying he won't sue...but that's no longer valid after he's gone, and he can't sign away the rights of the estate because it doesn't exist yet...so the signature does very little good if he dies or becomes incapacitated or injured as a result of the trip.

Personally, when doing ambulance or medical transport flights, I've always felt much better knowing that there are people in back to whom I'd trust my life, who are trained, experienced, and equipped to care for the patient...because no matter how qualified one may be, you cease to be of much help to the patient when you're the pilot. Your job at that point is to get the patient/passenger safely to the destination, not to work on the patient. Far, far better to carry others on board who can do that.

Gelande Strasse
24th Oct 2008, 09:19
Be very careful about taking sick people. This was a local tragedy!

BBC NEWS | Scotland | Helicopter crash probe concludes (http://news.bbc.co.uk/1/hi/scotland/4512026.stm)

GS

SNS3Guppy
24th Oct 2008, 09:28
According to the article, that flight had nothing to do with flying "sick passengers." A passing reference is made to the passenger collapsing, but the thrust of the article is flight in low visibility.

If the passenger is properly secured, including a properly tensioned shoulder harness, slumping into controls shouldn't be an issue.

Pilot DAR
24th Oct 2008, 09:43
Though I have less experience with this than other posters here, I quite agree with their observations. I would not transport anyone with a medical condition, which I believe could worsten, unless they were either a member of my family, or such transport was evidently desparately necessary to safe their life. There are people trained and equipped to do this, leave it to them.

As an experienced volunteer firefighter, I am often with people in need of medical care - sometimes alone for the first while. Prior to the arrival of medical staff, you move them as little as possible, and only if necessary. I've had patients easily sitting up talking to me when I arrived, die in the care of ambulance staff 15 minutes later because their condition worstened. Acting in the capacity of a pilot, you've got enough to think about without adding patient care, or even the distration. Family member along to help? Much worse! When things go bad, 90% chance they'll loose it, and now you're distracted by two patients!

When such requests are made of private aircraft owners (or even drivers), the very best thing to is to warmly and simpathetically say, "Oh, if only I could help you, but darn, the Automatic Direction Finder vacuum regulating rheostat just started dripping a purple liquid, and I'm waiting for a new one - it's weeks backordered - darn airplane! And how is X, gee it must be difficult...it must be worrying you..."

Leave it to the pros - they're trained, equipped, and not emotionally attached.

Pilot DAR

Pace
24th Oct 2008, 10:21
When people say they won't sue you legally, that's fine, but remember that it's the deceased's estate that sues...and that doesn't begin to exist until they're dead. Even the deceased can sign a waiver saying he won't sue...but that's no longer valid after he's gone, and he can't sign away the rights of the estate because it doesn't exist yet...so the signature does very little good if he dies or becomes incapacitated or injured as a result of the trip.

Guppy at what point do an airline require a Doctors letter as fit to travel? i know many turn passengers away not only for the reasons you put above but also for the huge costs and inconvenience a diversion might cause.

Who makes the descision whether to allow a borderline case passenger to board and with what guidelines?

I must admit when I was asked to do the trip I had massive reservations. The request was made through a friend and that also puts on pressure.
The guy died and that was a relief as it let me off the hook having agreed to do the trip.

I take the other points made in the thread of it being difficult if not dangerous being distracted from piloting duties by an emergency in the aircraft.

In my PPL days I can remember 3 occasions of being asked to take people up for a flight to cheer them up. One was dying with Cancer, the other had had a major operation and wore a bag (not a pleasant experience in an unpressurised plane for him or or the other on the aircraft) The third was paralysed in an accident and suffering with depression. The third brought about loading problems and fears of getting him out quickly if need be.

The above three are examples of what PPLs may be faced with and would be classified as pleasure flights rather than transport flights.

Pace

172driver
24th Oct 2008, 10:22
Agree with all of the above (and I have, too, been on medevac flights, albeit not as pilot), however, there is one comment that intrigues me:


Legally, this is tantamount to dying in France; yet, legally, he has not yet entered France ! !

I've always been under the impression that once airborne, you are in the country (and hence jurisdiction) of the country of registry of the a/c. So in this case, assuming Pace is flying a G-reg, the UK, no matter which airspace you're in. This situation would obviously change once on the ground.

Flying Lawyer ?

englishal
24th Oct 2008, 10:54
I wouldn't do it. We regularly transport people with broken backs, smashed up bodies, serious illness, and the most frightening for me, an unstable very premature 1 pound baby (in incubator, in bad weather). We have a doctor, or paramedic and all the kit onboard. The thought of doing it "solo" fills me with dread....

IO540
24th Oct 2008, 11:04
what if he were actually to die while you were in French airspace ? Legally, this is tantamount to dying in France;

According to a book I read (Air Babylon, I think) so this must be 100% copper bottomed fact because it wasn't on the internet, the airlines normally arrange for the death to occur just before the scheduled landing, which avoids all kinds of complications. Obviously this could be done only if the passenger is obviously dead when discovered. If he is just ill then you divert somewhere.

Legally (not a lawyer) it's pretty obvious the pilot cannot be personally liable for the sick passenger - if it is a proper air ambulance flight. The medical staff involved must carry the can for that, with insurance etc.

I would never do it solo.

foxmoth
24th Oct 2008, 11:18
the airlines normally arrange for the death to occur just before the scheduled landing, which avoids all kinds of complications.

I think you will find that he is nor "legally" dead until declared so by a doctor so this normally happens after landing.:\

AMEandPPL
24th Oct 2008, 11:22
I've always been under the impression that once airborne, you are in the country (and hence jurisdiction) of the country of registry of the a/c. So in this case, assuming Pace is flying a G-reg, the UK, no matter which airspace you're in. This situation would obviously change once on the ground.

Flying Lawyer ?

Will be very interesting to hear a qualified legal viewpoint on this ! The "G-reg = UK jurisdiction" approach would obviously make a lot of sense.
But I definitely remember being warned about deaths in foreign airspace on a couple of occasions while I was doing air ambulance work. It was a long time ago; maybe the laws have changed since then !

PS - I never did actually lose anyone in flight at all !

Pace
24th Oct 2008, 11:28
I think you will find that he is nor "legally" dead until declared so by a doctor so this normally happens after landing.

If thats the case and there is a Doctor on Board a medical flight or airline flight are they asked to delay declaring a death until after landing?

Does this happen with the airlines where a Doctor may be going on business or Holiday and attends a heart attack victim? Ie if this death happens mid flight, the Doctor tries to save him but then declares him dead where has he actually died?

Pace

BackPacker
24th Oct 2008, 11:37
I'm surprised that, based on the OP, people start having visions of the worst-case scenario, requiring doctors, nurses, vomiting, cardiac arrest, late-term pregnancy/premature birth etc. All the stuff you see on these 911-type reality TV shows. I think we all agree that something like that is best left to the specialists, if necessary in an ambulance-type aircraft with sufficient space for one or two pilots, a stretcher with the patient on it, and a doctor/nurse to perform whatever medical duties need to be performed. I also think there's a special medivac thing you can put in the flightplan for such flights, giving you priority in some cases. And these patients, upon arrival in a hospital, are not going to be moved anymore unless to a better equipped hospital.

But as far as I see it, the OP was asking about a situation with a patient having a chronic disease, would die rather soon, but was not expected to need immediate or continuous medical attention during the flight. Altogether a different situation, and a situation I find myself in every now and then.

My flying club has a number of charity events around the year where we take chronically ill or handicapped children up for a pleasure flight. They are, in their normal life, under regular control by a doctor, but are out of the hospital and there's no above-normal chance that their condition will all of a sudden worsen during the flight. We're talking physically or mentally handicapped children here, or chronic diseases like cancer.

We typically offer them a local pleasure flight of about 25 minutes, as part of a larger program. The route is chosen so that if the need should arise, we can announce a mayday and be on the ground in, say, five to ten minutes. For big events where we take multiple patients up in multiple flights, we inform ATC and the airport authorities beforehand, agree on routes, callsigns etc.

In each and every case, the patient has been signed out of the hospital by a doctor and in most cases we specifically ask the parents to check with the hospital to make sure the doctor doesn't see any objection to the flight. During the day itself we make a point of not discussing the disease with the patient, but we do have an agreement that certain types of diseases always require a parent or other responsible adult to accompany the child (lung diseases requiring the continuous use of oxygen for instance) or that the patient sits in the back, unable to reach the controls (mental illness, epilepsy).

So... As long as the patient has been discharged from hospital, and you have consulted with a doctor or other specialist to determine the specific patients disease and the effect it might have on the safety of the flight, I think you should be fine from a flight safety standpoint.

Should he die enroute you could theoretically be sued by the family for the death even if they gave consent?

You can be sued for anything. Question should be: Can you be convicted? Now in this particular case, everyone knew his death was imminent and there was nothing the medical establishment could do about it anymore. If he were to die in your aircraft, have you been negligent enough to get convicted for that? Ask yourself: if he were to die in your house, would you as the homeowner be responsible? If he were to die on a public street, would the government be responsible? I think if you would have talked things over with a doctor, and the doctor agreed that the flight would not make his medical condition any worse than it was (thus not increasing the chances of dying above what they were) you should not have a problem at all.

Some of the other problems would remain though. Obviously the patient should not in any way be able to decrease flight safety. Obviously you are going to plan your route more carefully, keeping a list of alternates with medical facilities to hand.

One last thought: There may be a legal problem in transporting somebody with a contagious disease from one country to another, regardless of whether the contagious disease is responsible for his condition or not. I don't think this would be relevant to your specific case, but it might be something to think about in another situation. I know a lot of hospitals will only accept patients who have been hospitalized in another country after a three-week quarantine period because of MRSA.

172driver
24th Oct 2008, 12:12
Backpacker, while I share your sentiments in general, I don't think you can compare a local jolly on a perfect day with transporting a terminally ill patient halfway across Europe. This, IMHO, is a medevac flight and should be undertaken by properly equipped crews.

Would I take someone flying on a local trip as a 'last wish' kind of thing? Definitely, if his doc agrees. Would I have undertaken the flight proposed to the OP? Definitely not.

AMEandPPL
24th Oct 2008, 12:17
Would I take someone flying on a local trip as a 'last wish' kind of thing? Definitely, if his doc agrees. Would I have undertaken the flight proposed to the OP? Definitely not

Perfect ! Could not have expressed it better myself !

SNS3Guppy
24th Oct 2008, 12:34
According to a book I read (Air Babylon, I think) so this must be 100% copper bottomed fact because it wasn't on the internet, the airlines normally arrange for the death to occur just before the scheduled landing, which avoids all kinds of complications. Obviously this could be done only if the passenger is obviously dead when discovered.


Airlines don't arrange for anyone to die. Or be declared dead, at any particular point in space or time. As a pilot it's not in my purview to make such a call, nor is it within my discretion or the airline's to elect when or where such a declaration takes place. Decisions are made based on safety of flight; a deceased passenger presents no risk to safety of flight.

If a diversion can safely be made and it may save a passenger, chances are that this is what will occur. Because neither I nor my employer can decide who lives or dies or how that this may occur, I can't state for a certainty that a passenger has died and make decisions on that assumption. Just imagine what be the case if the passenger could have been saved.

Unofficially I can tell you that what you often hear about medics working on someone feverishly until they officially expire at the hospital, isn't true. If someone is clearly dead, they're clearly dead. I've dealt with this on-scene on a number of occasions, and we don't pick up dead bodies and begin working on them to please families, the media, or anyone else. If they're dead, they're dead. The same applies to one onboard. If someone is beyond help, then we don't make a determination as to the time of death, we simply do our job.

Others can determine time or place of death after the fact; people who are qualified to make that determination.

I'm surprised that, based on the OP, people start having visions of the worst-case scenario, requiring doctors, nurses, vomiting, cardiac arrest, late-term pregnancy/premature birth etc. All the stuff you see on these 911-type reality TV shows.


It's not just on TV...it's what occurs to me because it's what I expect, what I've seen. It's not just hollywood drama. Real people vomit. Real people have heart attacks. Real people go into labor at inconvenient times...every day. However, you're correct, these aren't typically what a private pilot will carry, save for an unusual emergency.

What the original poster did ask about, however, is a medical patient who may have specific needs. Simple needs such as the carriage and use of oxygen. Many people don't know that oxygen is considered a drug...it's not just a canister of gas that's okay to administer as needed. Specific flow rates for specific conditions, based on administrative methods and masks, in response to changes in blood oxygen saturation and vitals, is applicable. Undertaking a medical patient under care, even if it's a terminal patient, is undertaking a potential risk, and undertaking a potential safety of flight issue.

I transported a woman once, and was told that she was simply being transported in order to visit a clinic. She sat up front with me. She was a very large Hopi Indian lady, and I elected to put her up front for the weight and balance. Upon arrival, she said she had a headache. I offered her a tylenol, and she said she couldn't take medication. She then told me she was going into a program for an attempted suicide. I wasn't informed of this before, or I certainly wouldn't have put this person close to the flight controls, and probably wouldn't have carried her at all. What is it that YOU don't know about the seemingly innocuous patient that you're carrying??

I've transported terminal cancer patients on a number of occasions, often with far more than just me...full suport from on board technicians, etc. The cancer patient may have a number of requirements, some of which might not even be manifest until the airplane is at a higher enroute altitude. Suppose you encounter complications at that point? What are you going to do? Benign, quiet terminal patient just became vomiting violently sick cancer patient with a seizure...now what?

So... As long as the patient has been discharged from hospital, and you have consulted with a doctor or other specialist to determine the specific patients disease and the effect it might have on the safety of the flight, I think you should be fine from a flight safety standpoint.


I used to think that too. You can learn that's not true based on unpleasant experience, or listen to others who learned the hard way. It's up to you.

You can be sued for anything. Question should be: Can you be convicted? Now in this particular case, everyone knew his death was imminent and there was nothing the medical establishment could do about it anymore. If he were to die in your aircraft, have you been negligent enough to get convicted for that? Ask yourself: if he were to die in your house, would you as the homeowner be responsible? If he were to die on a public street, would the government be responsible? I think if you would have talked things over with a doctor, and the doctor agreed that the flight would not make his medical condition any worse than it was (thus not increasing the chances of dying above what they were) you should not have a problem at all.


Very dangerous counsel to give...and yes, you could very easily be sued for the expiration in your home, or your aircraft. If you can be associated with it, you would be foolish to think having spoken to a doctor or having a slip of paper will excuse you from litigation.

Guppy at what point do an airline require a Doctors letter as fit to travel? i know many turn passengers away not only for the reasons you put above but also for the huge costs and inconvenience a diversion might cause.


You're not required to prove you're fit for travel. If you require special accomodations and ask when you purchase your ticket, you may find that such accomodations are not available. A common scenario for an international non-critical transport is to purchase a block of seats and have a litter or station installed with which to transport. This is something we had to do in the past for international flights. Typically 9 or more seats had to be purchased, and we would supply the sled and equipment. The sled comes with internal power suction, oxygen, attachments, etc.

If someone undertakes travel knowing they're unable, they take upon themselves certain liabilities and risks.

Can you imagine the delays and trouble that would ensue if every passenger were required to provide a doctor's note in order to fly?

BackPacker
24th Oct 2008, 12:41
Would I take someone flying on a local trip as a 'last wish' kind of thing? Definitely, if his doc agrees. Would I have undertaken the flight proposed to the OP? Definitely not.

Although I honestly have to agree I share the same feeling I wonder what the difference, and therefore the deciding factor, really is.

I don't think flight safety considerations would be different between the local jolly and the intended transportation flight. I assume that the OP and his aircraft would be quite capable of making the flight in one go, so no hassle with an intermediate refueling stop. In a further post Pace referred to an unpressurized twin at 10.000 feet so I assume an IR, and thus weather should not be a problem, and neither should be a fairly long overwater crossing to get a direct route.

Yes, with a longer flight duration the chances of the patient dying en-route increase too, but they increase linearly unless the sickness is somehow airpressure related. (Probably not a good idea to take a lung cancer patient to 10.000 feet...)

Or would it be lack of suitable alternates if something does go wrong? Or maybe some sort of legal issue, like immigration of a sick person, quarantine (MRSA like I mentioned) or the legal complexities of somebody dying en-route?

If a person dies on a local jolly, or on an international transportation flight, I guess the family is just as likely to sue (or not).

Note that I'm still assuming that the flight can be made without any medical staff in direct attendance. So we're not talking a medivac flight with all the bells and whistles, in which case I agree that even a local jolly is best left to the professionals.

Pace
24th Oct 2008, 13:52
Would I take someone flying on a local trip as a 'last wish' kind of thing? Definitely

172 Driver in some ways there is an element of truth to the fact that it is probably "safer" flying an ill patient on a longer flight than a short one?

The longer flight probably means a larger multi engine aircraft with the sick person accompanied by a friend or whatever in the back and away from the cockpit invironment.

Contrast that to the hour local sightseeing flight in a single engine aircraft.
Maybe the sick person is in the front in a cramped situation.
Someone having a serious seizure could have large implications to that flight?

Yet those sort of good will type of flights in light aircraft with low time pilots probably happen far more frequently than can be imagined.
While the pilots probably dont realise the risks involved.

Maybe AMEandPPL could advise as an AME what conditions are accpeptable and what medical conditions should be avoided not only to safeguard the sick person but the aircraft itself.

I have never seen any guidelines from the CAA. I am in this instance talking about good will PPL pleasure flights rather than longdistance Medivac style movements.

Pace

IO540
24th Oct 2008, 14:12
As BP says, it's obviously OK to do short flights with terminally ill people. I am sure that after all these years some lawyer has had a look into it...

Also, if I am terminally ill, and get discharged from hospital to die at home, I could take up snowboarding or skydiving, for all that anybody cares - so long as I can physically do it obviously. Is the pilot of the dropping plane going to get done if I die while airborne?

The difference is that he may or may not know I was ill, whereas the OP here presumably does know.

So, the only problem I see is the practical one - can the passenger make the journey?

There are plenty of "normal" people I would not do that trip with :)

AMEandPPL
24th Oct 2008, 14:17
what conditions are acceptable, and what medical conditions should be avoided, not only to safeguard the sick person but the aircraft itself.

I have never seen any guidelines from the CAA

I don't think there are any "guidelines" from the CAA on this particular subject. My general feeling about this is that any Commander of any aircraft must exercise Common Sense and Good Airmanship. Adherence to those two will avoid or resolve most of the likely pitfalls.

I would hesitate to be drawn on which medical conditions are acceptable and which should be avoided. From a physiological point of view a quick local jolly in a C172 is really no more likely to be harmful than a ride in a car in the Scottish Highlands ( ie similar altitude AMSL !).

My greatest worry, which has been referred to previously, would be that the PIC's total control of the aircraft was, in any way, impaired. Slumping over the RHS control yoke in death is a very extreme example.
The PIC's movements may be limited if the person in the RHS is extremely obese - I have personal experience of that one ! Mental capacity to obey instructions, and NOT touch anything, could also be very important. You can just see it, can't you . . . . . "What does this lever do, then ?" as he unexpectedly retracts your flaps on very short finals !

I think I'll stick to my regular passengers most of the time !

BackPacker
24th Oct 2008, 15:32
I would hesitate to be drawn on which medical conditions are acceptable and which should be avoided.

I realize that each case is unique and that we should, ideally, consult a doctor in every case. But sometimes we don't, not for a quick jolly around the circuit.

Obviously, as someone who is not a doctor, I'm using my best judgment as to what I can and can't do. For example, obese persons, even if 100% fit, should not interfere with the full range of control travel and should not lead to an out-of-balance situation, otherwise the flight is off. Somebody with a mental illness, suicide attempt history, epilepsy or a history of not listening to commands should not be able to grab the controls. Somebody who might die in flight, or suffer from narcolepsy or something similar should be restrained with a shoulder harness so that he/she cannot fall forward and restrict control movement. Somebody with a significant physical or mental disability, requiring assistance from the outside to get in/out, should not be blocking the only exit (PA-28 comes to mind). Somebody with a lung disease should not be in a high-flying unpressurized aircraft and you also need to take care when flying at altitude, with somebody who pees or poos in a bag. And so on and so forth.

But are there any medical conditions which might have an unexpected effect on flight safety, which someone who is not a doctor might not think about? Not looking for a full and exhaustive list, but simply stuff I haven't thought of.

AMEandPPL
24th Oct 2008, 17:05
But are there any medical conditions which might have an unexpected effect on flight safety, which someone who is not a doctor might not think about?

Well done ! In that previous paragraph I think you've covered most of the things most of us would be primarily concerned about !

I would add just two more. The first would be any kind of ANAEMIA. Where the haemoglobin is low, looks pale, short of breath, easily tired, etc etc. Because oxygen diminishes as we climb up in the atmosphere an anaemic person who JUST copes OK at ground level can become very distressed at a normal airliner cabin altitude ( approx 7000 ft). It would have to be very bad anaemia, though, to preclude a local jolly at around 2000 ft !

The other one to be very wary indeed of is middle ear conditions, such as infections or Meniere's disease. The unaccustomed movements of an aircraft (in all directions), plus the inevitable pressure changes, could give rise to some very distressing symptoms. Might also aggravate motion sickness, and the last thing the PIC wants is anyone puking in his direction !

The point about both these two is that the problems might not be apparent at ground level, and a non-aviation-minded patient or relative might not be aware of the changes once airborne.